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Medical follow-up of living kidney donors by 1 year after nephrectomy
P P Reese1, M K Simon, J Stewart
1Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA. peter.reese@uphs.upenn.edu
Insights
Many kidney donors lack adequate medical care post-nephrectomy. Medically complex donors and older age were associated with better follow-up rates, suggesting targeted interventions are needed for kidney donor care.
Area of Science:
- Nephrology
- Transplant Surgery
- Public Health
Background:
- Kidney donor post-nephrectomy care is a growing concern.
- A policy was implemented recommending 12-month follow-up for kidney donors.
- This study investigated factors influencing follow-up adherence.
Purpose of the Study:
- To determine the rate of adequate medical follow-up among kidney donors.
- To identify predictors of adequate follow-up after nephrectomy.
- To test the hypothesis that medically complex donors have higher follow-up rates.
Main Methods:
- Retrospective cohort study of 137 live kidney donors.
- Medically complex donors defined by specific health criteria (hypertension, obesity, etc.).
- Adequate follow-up defined by nephrologist visit or essential lab tests.
Main Results:
- 61% of donors (83/137) received adequate follow-up within 12 months.
- Medically complex donors were more likely to have adequate follow-up (OR 2.48, P=.02).
- Older donors also showed higher rates of adequate follow-up (OR 1.46 per decade, P=.04).
Conclusions:
- A significant portion of kidney donors do not receive recommended post-nephrectomy care.
- Medically complex and older donors are more likely to receive recommended follow-up.
- Further strategies are needed to ensure all kidney donors receive adequate medical care.
Background:
Concerns have been raised that many kidney donors do not receive adequate medical care after nephrectomy. In 2003, our program developed a policy recommending that donors receive medical follow-up by 12 months postnephrectomy. We hypothesized that medically complex donors would have a higher rate of follow-up than other donors.
Methods:
A retrospective cohort study of 137 live kidney donors from a single center was performed. Donors were considered medically complex if they had hypertension, body mass index of 30 or greater, nephrolithiasis, age 65 years or older, creatinine clearance less than 80 mL/min/1.73 m(2), or had a first-degree relative with diabetes mellitus. Adequate follow-up was defined as one visit with a nephrologist at our center, or blood pressure, serum creatinine, and urinalysis checked elsewhere.
Results:
Eighty-three donors (61%) had adequate follow-up, 42 did not, and 12 could not be contacted. At multivariate logistic regression, donors with adequate follow-up were more likely to be medically complex (odds ratio, 2.48; 95% confidence interval 1.18-5.23; P = .02) and older than donors with inadequate follow-up (odds ratio, 1.46 per 10 years of age; 95% confidence interval, 1.01-2.10; P = .04).
Conclusion:
A substantial minority of donors do not receive recommended care by 1 year after nephrectomy.
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